Multicystic encephalopathy: review of eight cases with etiologic considerations.

Multicystic encephalomalacia (MCE) is a rare lesion that arises during the perinatal period. Although hypoxic-ischemic insults may be responsible for this lesion, recent evidence suggests that herpesviruses may represent another etiologic agent. To elucidate the pathogenesis of MCE, eight cases collected over a 34-year period were evaluated for destructive lesions in gray and white matter. Immunocytochemical methods, in situ hybridization and polymerase chain reaction (PCR) methodology were employed to search for herpes simplex viruses types 1 and 2 (HSV1 and HSV2), cytomegalovirus (CMV), varicella zoster virus (VZV), Epstein-Barr virus (EBV) and JC variant of papovavirus (JCV). Review of the clinical histories revealed that there had been a complicated labor and delivery in 6/7 cases. Neuropathological lesions consisted of extensive tissue destruction, neuronal loss and gliosis in hemispheric white matter, cerebral cortex, basal ganglia, thalamus, cerebellum and brainstem tegmentum. Only one case showed evidence of latent HSV infection by PCR. CMV, VZV, JCV and EBV were not detected. Arteriopathy was noted in one case. The widespread nature of the lesions and their association with perinatal ischemia suggest that severe hypoxia may be the more common etiology of MCE. Term infants appear especially susceptible to this type of cerebral damage.

Immunohistochemical detection of myelin basic protein is a sensitive marker of myelination in second trimester human fetal spinal cord.

The Luxol fast blue (LFB) technique is widely used for the assessment of myelination. Lectin histochemistry using peanut agglutinin (PNA) has also been employed for this purpose. Recently, immunohistochemical methods using antibodies to several myelin-related proteins have been adopted to study myelination in humans. However, the relative sensitivities of these different methods for the detection of early myelination in the human fetal central nervous system have not been determined. Vibratome sections of cervical spinal cord from 15 human abortuses ranging in age from 15 to 24 gestational weeks (GW) were probed with immunohistochemical methods using antibodies to myelin basic protein (MBP), 2',3'-cyclic nucleotide 3'-phosphodiesterase (CNPase), and myelin-associated glycoprotein (MAG). In addition, LFB and PNA histochemistry was employed. The degree of myelination observed in immunohistochemically stained sections was compared to that found in corresponding LFB- and PNA-stained paraffin-embedded tissues. The intensity of myelination was graded by two observers on a scale of 0 (none), +1 (mild), +2 (moderate), and +3 (marked). At all ages examined, the MBP immunohistochemical method revealed more myelin than LFB or MAG staining. CNPase could not be reliably detected until after 18 GW. Peanut agglutinin stained myelin, but subpial astrocytes and the intervening neuropil were also stained. These results suggest that MBP is a more sensitive marker for early human fetal myelination than CNPase, MAG, PNA or LFB.

Temporal and spatial expression of major myelin proteins in the human fetal spinal cord during the second trimester.

Immunohistochemical identification of myelin basic protein (MBP) is a sensitive method for assessing myelination in the human fetal central nervous system (CNS). However, the temporospatial relationship of expression of two other major myelin proteins, proteolipid protein (PLP) and myelin-associated glycoprotein (MAG) to that of MBP during fetal development has not been assessed in human tissues. Vibratome sections of cervical, thoracic and lumbosacral levels from 37 normal spinal cords of < or = 10 to 24 gestational week (GW) fetuses were analyzed using immunohistochemical methods. Using light microscopy, MBP was the first oligodendrocyte marker detected, present by 10 GW at more rostral levels. PLP and MAG were detected rostrally between 12 to 14 GW. All myelin proteins were expressed in anterior to posterior and rostral to caudal gradients. By the late second trimester, expression of MBP, PLP and MAG was noted in all locations in the spinal white matter except for the corticospinal tract. Expression of MAG was particularly marked in the posterior root entry zone and propriospinal tracts. The results suggest that PLP and MAG are expressed later than MBP but follow similar spatial gradients.